BILLING NEWS

Arizona Approves Law Targeting Out-of-Network Bills

May 26, 2017

Arizona Gov. Doug Ducey signed into law bill S.B. 1441 that allows health plan enrollees who receive an unanticipated medical bill from an out-of-network (OON) provider to dispute the bill through claims arbitration. The measure bans balance billing of patients for bills over $1,000 that are subject to arbitration, but only after the patient agrees to make payment to the provider for applicable co-payments, deductibles, and co-insurance. The new law takes effect Jan. 1, 2019. Under the bill, consumers can ask the Arizona Department of Insurance to assign an arbitrator to settle the dispute if they receive a bill of $1,000 of more from OON providers. However, patients, insurers, and providers must first try to settle the dispute through a settlement teleconference before proceeding to arbitration. The measure requires the department to develop a simple, fair, efficient and cost-effective arbitration procedure for bill disputes and specifies time frames, standards and other details of arbitration. For example, arbitration must be conducted within 120 days after a request is received, a final decision must be rendered within 10 business days, and the cost of arbitration must be split between the insurer and provider.